All Insurance Policy Changes (Page 773)

Continuing from page 772. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
5160:1-3-05.20 - Medicaid: deeming of resources. (Amend/Final File)
Ohio Medicaid·Effective Feb 15, 2026
Ohio Department of Medicaid has filed a final amendment to rule 5160:1-3-05.20 regarding the deeming of resources for Medicaid eligibility determination. This change affects how financial resources are evaluated when determining patient Medicaid qualification.
Medium impact
5160:1-3-03.3 - Medicaid: deeming of income. (Amend/Final File)
Ohio Medicaid·Effective Feb 15, 2026
Ohio Department of Medicaid has updated Rule 5160:1-3-03.3 regarding income deeming requirements for Medicaid eligibility determination. This administrative change affects how patient income is calculated for Medicaid qualification, which may impact patient eligibility status and coverage verification processes.
High impact
Newsletter Vol. 2, No. 15
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid has updated requirements for completing Field 81 on the UB-92/HCFA claim form for inpatient hospital DRG claims. The field must contain exactly 14 characters in a specific order: medical record number (positions 1-9), readmission status (position 10), DRG number (positions 11-13), and outlier indicator (position 14).
Medium impact
5160:1-2-12.1 - Medicaid: sponsored non-citizens. (New/Final File)
Ohio Medicaid·Effective Feb 15, 2026
Ohio has established new Medicaid eligibility rules for sponsored non-citizens under rule 5160:1-2-12.1. This creates new coverage pathways for certain immigrant populations who have sponsors, potentially expanding Medicaid eligibility for this group.
High impact
Newsletter Vol. 2, No. 16
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid has updated claim preparation requirements to reduce suspensions and denials. Key changes include mandatory use of 7-digit provider billing numbers, 12-digit recipient case numbers, original signatures only, proper date sequencing, and strict adherence to ICD-CM/HCPCS coding standards.
Medium impact
5160-1-32.1 - Standard authorization form. (New/Final File)
Ohio Medicaid·Effective Feb 16, 2026
Ohio Department of Medicaid has updated their standard authorization form for prior authorization requests. This is a procedural change to the form used when submitting prior authorization requests to Ohio Medicaid.
Medium impact
Newsletter Vol. 2, No. 17
New Jersey Medicaid·Identified Jun 20, 2026
Blue Cross/Blue Shield United of Wisconsin has been announced as the new Medicaid contractor for Freestanding Home Health Agencies in New Jersey. This represents a change in the administrative contractor handling Medicaid claims for home health services in the state.
Medium impact
5160-1-32.1 - Standard authorization form. (Rescind/Final File)
Ohio Medicaid·Effective Feb 16, 2026
Ohio Department of Medicaid is implementing a new standard authorization form for prior authorization requests. The policy shows a rescission and replacement pattern, with the most recent final filing effective February 16, 2026.
High impact
Newsletter Vol. 2, No. 18
New Jersey Medicaid·Effective Mar 1, 1974
Blue Cross and Blue Shield of New Jersey (BCBSNJ) is now the designated Medicaid Settlement Agent for New Jersey hospitals and home health agencies, responsible for calculating settlements, per diem adjustments, and outpatient percentage rate changes. Unisys Paramax remains the fiscal agent for claims processing and fund disbursement. Providers must understand new timelines for disbursements (20 working days), recoupments (30-day notice before withholding), and the option to submit alternative repayment schedules to avoid payment withholding.
Low impact
5160:1-3-03.10 - Medicaid: retirement funds. (Rescind/Final File)
Ohio Medicaid·Effective Mar 1, 2026
Ohio Medicaid has updated Rule 5160:1-3-03.10 regarding retirement funds eligibility criteria. The rule change involves rescinding the previous version and implementing a new version with updated requirements for how retirement accounts are treated in Medicaid eligibility determinations.
Medium impact
Newsletter Vol. 2, No. 19
New Jersey Medicaid·Identified Jun 20, 2026
Garden State Health Plan (GSHP) has updated its reimbursement policy for over-the-counter (OTC) drugs for their members. This policy change affects how OTC medications will be covered and reimbursed going forward.
Low impact
5160:1-3-03.10 - Medicaid: retirement funds. (New/Final File)
Ohio Medicaid·Effective Mar 1, 2026
Ohio Department of Medicaid has updated rule 5160:1-3-03.10 regarding retirement funds for Medicaid eligibility determination. This policy change involves rescinding the previous rule and implementing a new version effective March 1, 2026.
Low impact
Newsletter Vol. 2, No. 20
New Jersey Medicaid·Identified Jun 20, 2026
This policy addresses updating the Fiscal Agent Provider File when a long-term care facility changes its pharmacy provider or when there are changes in the level of pharmacy services provided. This is an administrative update process for Medicaid provider enrollment records.
Medium impact
5160-11-21 - Portable x-ray supplier services. (Amend/Final File)
Ohio Medicaid·Effective Mar 9, 2026
Ohio Department of Medicaid has amended Rule 5160-11-21 governing portable x-ray supplier services. The amendment was originally filed on 11/21/2025 with a final file date of 02/25/2026 and effective date of 03/09/2026.
Low impact
Newsletter Vol. 2, No. 7
New Jersey Medicaid·Identified Jun 20, 2026
The policy document appears to be incomplete or corrupted, showing only page markers (1 of 4, 2 of 4, etc.) without any actual policy content. No specific changes, requirements, or billing information can be determined from this document.
Medium impact
5160-11-31 - Independent diagnostic testing facility (IDTF) services. (Amend/Final File)
Ohio Medicaid·Effective Mar 9, 2026
Ohio Department of Medicaid has updated rule 5160-11-31 regarding Independent Diagnostic Testing Facility (IDTF) services, with the final amendment taking effect March 9, 2026. This policy change affects how IDTFs must operate and bill for diagnostic services under Ohio Medicaid.
Medium impact
Medicaid Alert - MA-1992-06
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid has implemented Edit Code 800 to identify and flag exact duplicate bills in their system. This code will be assigned to claims that are identical duplicates of previously submitted claims to prevent duplicate payments.
Low impact
5160-59-03.6 - Psychiatric residential treatment facility (PRTF) service. (Amend/Original File)
Ohio Medicaid·Effective Apr 13, 2026
Ohio Department of Medicaid has filed an amendment to rule 5160-59-03.6 governing Psychiatric Residential Treatment Facility (PRTF) services. This is an amendment to existing regulations that will become effective April 13, 2026.
Medium impact
Medicaid Alert - MA-1992-07
New Jersey Medicaid·Identified Jun 20, 2026
New Medicaid policy MA-1992-07 provides clarified billing instructions for optical appliances. This is a very recent 1-day old policy that updates coding guidance for vision-related medical equipment and devices.
Low impact
5160-15-27 - Transportation: services from an eligible provider: documentation. (Amend/Original File)
Ohio Medicaid·Effective Apr 16, 2026
Ohio Department of Medicaid has filed an amendment to Rule 5160-15-27 regarding documentation requirements for transportation services from eligible providers. This policy specifically affects Medicaid transportation benefit billing and documentation standards.
Medium impact
Newsletter Vol. 2, No. 21
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid has added four pharmaceutical manufacturer labeler codes to its approved list: Scott Tussin Pharmaceutical Company Inc, Nephron Pharmaceutical Corporation, Ethex Corporation, and Whitby Pharmaceutical. Billing teams must update their pharmaceutical dispensing systems to recognize and process claims for medications from these newly approved manufacturers without rejection.
Medium impact
5160:1-6-04 - Medicaid: treatment of income and resources for an institutionalized spouse with a spouse in the community. (Amend/Final File)
Ohio Medicaid·Effective Apr 1, 2026
Ohio Medicaid updated Rule 5160:1-6-04 regarding income and resource treatment for institutionalized spouses with community-dwelling spouses. This affects Medicaid eligibility determinations for patients in long-term care facilities whose spouses remain at home.
High impact
Newsletter Vol. 2, No. 22
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid has transitioned fiscal agents from Blue Cross/Blue Shield and Prudential to UnisysParamax. Providers must resubmit previously unprocessed claims to the new fiscal agent, with specific requirements depending on whether claims fall within or outside the 12-month timely filing window. Claims within 12 months of service must be resubmitted on new forms by the 12-month deadline; older claims require proof of prior timely submission to the former fiscal agents.
Medium impact
5160:1-5-04 - Medicaid: Ohio workability. (Amend/Final File)
Ohio Medicaid·Effective Apr 1, 2026
Ohio Medicaid Rule 5160:1-5-04 regarding Ohio workability requirements has been amended with an effective date of April 1, 2026. This policy appears to address Medicaid eligibility requirements related to work ability assessments in Ohio.
Medium impact
Medicaid Alert - MA-1992-08
New Jersey Medicaid·Identified Jun 20, 2026
New Medicaid policy requires use of MODIFIER XE for specific billing scenarios. This is a fresh policy update that may affect how certain procedures are billed to Medicaid plans.

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Archive by year

2023 2024 2025 2026

5160:1-3-05.20 - Medicaid: deeming of resources. (Amend/Final File)

5160:1-3-03.3 - Medicaid: deeming of income. (Amend/Final File)

Newsletter Vol. 2, No. 15

5160:1-2-12.1 - Medicaid: sponsored non-citizens. (New/Final File)

Newsletter Vol. 2, No. 16

5160-1-32.1 - Standard authorization form. (New/Final File)

Newsletter Vol. 2, No. 17

5160-1-32.1 - Standard authorization form. (Rescind/Final File)

Newsletter Vol. 2, No. 18

5160:1-3-03.10 - Medicaid: retirement funds. (Rescind/Final File)

Newsletter Vol. 2, No. 19

5160:1-3-03.10 - Medicaid: retirement funds. (New/Final File)

Newsletter Vol. 2, No. 20

5160-11-21 - Portable x-ray supplier services. (Amend/Final File)

Newsletter Vol. 2, No. 7

5160-11-31 - Independent diagnostic testing facility (IDTF) services. (Amend/Final File)

Medicaid Alert - MA-1992-06

5160-59-03.6 - Psychiatric residential treatment facility (PRTF) service. (Amend/Original File)

Medicaid Alert - MA-1992-07

5160-15-27 - Transportation: services from an eligible provider: documentation. (Amend/Original File)

Newsletter Vol. 2, No. 21

5160:1-6-04 - Medicaid: treatment of income and resources for an institutionalized spouse with a spouse in the community. (Amend/Final File)

Newsletter Vol. 2, No. 22

5160:1-5-04 - Medicaid: Ohio workability. (Amend/Final File)

Medicaid Alert - MA-1992-08